The use of electrical stimulation to increase quadriceps femoris muscle force in an elderly patient following a total knee arthroplasty.

BACKGROUND AND PURPOSE: Persistent residual quadriceps femoris muscle force deficits after total knee arthroplasty (TKA) are commonly reported and can prevent patients from returning quickly and fully to functional activities. Neuromuscular electrical stimulation offers a potentially more effective means of increasing muscle force than current rehabilitation protocols. CASE DESCRIPTION: The patient was a 66-year-old man. Neuromuscular electrical stimulation for increasing quadriceps femoris muscle force was initiated 3 weeks after TKA for 11 sessions to supplement stretching exercises and a high-intensity volitional strengthening program. OUTCOME: The patient's isometric quadriceps femoris muscle force increased from 50% (involved/uninvolved) at 3 weeks after surgery to 86% at 8 weeks after surgery. A concurrent increase in his uninvolved quadriceps femoris muscle force concealed the patient's true increase in his involved quadriceps femoris muscle force in a side-to-side comparison. The patient's final involved quadriceps femoris muscle force (10 weeks after surgery) was 93% of the initial uninvolved quadriceps femoris muscle force. DISCUSSION: Our patient was able to return to independent activities of daily living and recreational activities, with force gains that surpassed those reported in the literature.     

脊神经前根吻合重建脊髓损伤大鼠的股四头肌功能

背景：如何重建脊髓损伤肢体运动功能对截瘫患者具有重要的意义。目的：探索利用脊髓损伤平面以上健存的脊神经前根与支配股四头肌的腰神经建立神经通路,恢复脊髓损伤后股四头肌的神经支配和肌收缩功能。方法：对清洁级SD大鼠L1神经根的前根与L3神经根的前根进行显微吻合。经一段时间（6个月）的轴突再生后,期望建立新的肌肉收缩功能。神经缝合后6个月,在破坏L2脊髓节段前后,分别进行神经电生理检测,观察股四头肌神经支配情况。结果与结论：在同侧L2半切脊髓前后,电刺激移植神经干时可记录到股四头肌的收缩肌电图。在同侧L2半切脊髓前后,电刺激L1感觉根时可同样在股四头肌记录到肌电图。说明利用脊髓损伤平面以上健存的L1神经根前根与L3神经前根移植吻合能重建新的股四头肌神经支配反射通路,并使股四头肌低级反射中枢上移。     

Sonographic Overview of Usual and Unusual Disorders of the Rectus Femoris Tendon Origins

Rectus femoris muscle proximal injuries are not rare conditions. The proximal rectus femoris tendinous anatomy is complex and may be affected by traumatic, microtraumatic, or nontraumatic disorders. A good knowledge of the proximal rectus femoris anatomy allows a better understanding of injury and disorder patterns. A new sonographic lateral approach was recently described to assess the indirect head of the proximal rectus femoris, hence allowing for a complete sonographic assessment of the proximal rectus femoris tendons. This article will review sonographic features of direct, indirect, and conjoined rectus femoris tendon disorders.     

Effect of Different Forefoot and Heel Support Surfaces on the Activities of the RF and HAM Muscles during the Sit-to-stand Task while Wearing High-heel Shoes

[Purpose] The purpose of this study was to show the effect of different forefoot and heel support surfaces on the activities of the rectus femoris and medial hamstring muscles during the sit-to-stand task while wearing high-heel shoes. [Subjects] Fifteen female subjects were recruited. [Methods] The muscle activities of the rectus femoris and hamstring muscles were recorded using an MP150 system during the sit-to-stand task while wearing various high-heeled shoes. [Results] The activities of the rectus femoris and medial hamstring muscles significantly decreased when subjects wore condition 1 shoes compared with when they wore condition 2, 3 or 4 high-heeled shoes. The activities of the rectus femoris and medial hamstring muscles significantly decreased when subjects wore condition 2 high-heeled shoes compared with condition 3 or 4 high-heeled shoes. [Conclusion] The results can be interpreted as indicating that the size of the forefoot supporting surface can influence the lower extremity muscles of women wearing high-heeled shoes more than the size of the heel supporting surface.Key words: High-heeled shoes, Imbalance, Sit-to-stand     

不同角度股四头肌负重训练对全膝关节置换术患者康复的影响

目的 探讨人工全膝关节置换术患者手术前后应用不同角度股四头肌板进行负重训练对患肢股四头肌肌力和关节功能康复的影响.方法 选择2010年9月～2011年2月本科室收治的36例行单侧人工全膝关节置换术患者,随机分为实验组和对照组,每组各18例.对照组采用常规股四头肌等长收缩训练,实验组应用股四头肌板和砂袋进行股四头肌负重训练,比较两组患者术前1d和术后第14 d膝关节活动范围(Range Of Motion,ROM)和美国膝关节学会评分(American Knee Society,AKS)的差异,以及两组患者术后达到直腿抬高的时间.结果 实验组患者术后第14 d ROM大于对照组,AKS评分高于对照组,达到直腿抬高的时间短于对照组(均P＜0.05).结论 人工全膝关节置换术患者手术前后应用可调不同角度的股四头肌板进行负重训练,可加快患肢股四头肌肌力和关节功能康复,提高治疗效果.     

股直肌腱中1/3与前交叉韧带的生物力学比较

背景:股直肌腱已成为重建前交叉韧带的重要替代物。目的:比较股直肌腱中1/3和前交叉韧带的生物力学特性。方法:标本于死者死亡后9.0~10.0h解剖取下股直肌腱和前交叉韧带,取下后立刻用以生理盐水浸湿的纱布包裹,密封后置于-20℃冰箱内保存。实验前取出标本,切取试样,股直肌腱和前交叉韧带每组共10个试样。结果与结论:股直肌腱中1/3的单位模量是前交叉韧带的63%,单位最大载荷为63%,提示股直肌腱中1/3是适合作为交叉韧带重建物的。     

Activity of the Femoral Muscles during Toe-gripping Action

[Purpose] In the present study, we investigated femoral muscle activity during toe-gripping, and the role of the femoral muscles in toe-gripping strength. [Subjects] Fourteen healthy young women were selected. [Methods] We measured the maximum voluntary contraction of the rectus femoris and long head of the biceps femoris muscles. We then calculated the percent integrated EMG (%IEMG) during the toe-gripping action. [Results] We found that the %IEMG of the biceps femoris was significantly higher than that of the rectus femoris. Moreover, a significant positive correlation was found between the %IEMG of the rectus femoris and that of the biceps femoris. [Conclusion] These results suggest that femoral muscles co-contract during the toe-gripping action, and thus possibly contribute to knee joint stability.     

表面肌电结合等速测试仪评价功能性电刺激对脑卒中患者下肢痉挛及其功能影响的临床研究

目的:运用表面肌电结合等速测试仪探讨基于正常行走模式的功能性电刺激(FES)对脑卒中患者下肢痉挛及功能的影响.方法:54例脑卒中患者随机分为2组,FES组及安慰刺激组(对照组).2组患者均接受常规的临床及康复治疗.FES组在此基础上接受基于正常行走模式的FES治疗,安慰刺激组给予无电流输出的电刺激.治疗前及治疗4周后,...     

An electromyographic analysis of quadriceps femoris muscle setting and straight leg raising

Physical therapists routinely advise patients to perform quadriceps femoris muscle setting or straight leg raising or both following knee surgery or trauma from knee injury. Little information exists, however, about the intensity of effort required from knee and hip musculature during the exercises. This study was designed to compare the level of electromyographic activity during maximally resisted straight leg raises with the level during quadriceps femoris muscle setting exercises for the vastus medialis, rectus femoris, gluteus medius, and biceps femoris muscles. Forty healthy young adult men and women performed randomly ordered trials of each exercise in the supine position. Electromyographic activity was recorded from surface electrodes and normalized to values derived from maximal isometric trials. Statistical analysis demonstrated significantly greater (p less than .0001) vastus medialis, biceps femoris, and gluteus medius muscle activity during quadriceps femoris muscle setting. The rectus femoris muscle was significantly more active (p less than .0001) during the straight leg raise. The study demonstrated remarkably different muscle activation levels between the exercises studied and clearly indicates that selection of the exercises needs to be based on the therapeutic objectives.     

Effect of botulinum toxin injection on length and lengthening velocity of rectus femoris during gait in hemiparetic patients

Background

In hemiparetic patients, rectus femoris spasticity is one of the main causes of reduced knee flexion in swing phase, known as stiff knee gait. Botulinum toxin is often used to reduce rectus femoris spasticity and to increase knee flexion during swing phase. However, the mechanisms behind these improvements remain poorly understood. The aim of this study was (1) to quantify maximal rectus femoris length and lengthening velocity during gait in ten adult hemiparetic subjects with rectus femoris spasticity and stiff knee gait and to compare these parameters with those of ten healthy subjects and (2) to study the effect of botulinum toxin injection in the rectus femoris muscle on the same parameters.

Methods

10 patients with stiff knee gait and rectus femoris spasticity underwent 3D gait analysis before and one month after botulinum toxin injection of the rectus femoris (200 U Botox®, Allergan Inc., Markham, Ontario, CANADA). Rectus femoris length and lengthening velocity were quantified using a musculoskeletal model (SIMM®, MusculoGraphics, Inc., Santa Rosa, California, USA).

Findings

Maximal length and lengthening velocity of the rectus femoris were significantly reduced on the paretic side. There was a significant increase in muscle length as well as lengthening velocity during gait following botulinum toxin injection.

Interpretation

This study showed that botulinum toxin injection in the spastic rectus femoris of hemiparetic patients improves muscle kinematics during gait. However maximal rectus femoris length did not reach normal values following injection, suggesting that other mechanisms are likely involved.     

Responses to whole head-and-body tilts with and without passive ankle dorsiflexion in the absence of visual feedback

OBJECTIVES: We have investigated lower limb responses in seven blindfolded healthy subjects to well controlled tilts in the standing position. Our aims were (1) to determine the effect of head acceleration magnitude on responses evoked by whole head-and-body tilts, and (2) to establish whether tilt-evoked responses are modifiable by passive ankle dorsiflexion. Whole head-and-body tilts evoked responses in the biceps femoris, medial gastrocnemius and tibialis anterior muscles. METHODS: Seven young healthy subjects stood on a spring-activated tilting apparatus and underwent sudden whole head-and-body tilts of about 15 degrees from the vertical position, with or without passive ankle dorsiflexion. Head acceleration was recorded with a linear accelerometer and ankle angular displacement with a potentiometer. Surface EMG signals were recorded in the right biceps femoris, medial gastrocnemius and tibialis anterior muscles. RESULTS: As the peak of head acceleration was increased from 0.5 g to 1.8 g, the frequency of occurrence of tilt-evoked responses increased from 7% to 60% of trials in the biceps femoris muscle during whole head-and-body tilts. In general, the more proximal muscle (biceps femoris) was activated before the more distal muscle (medial gastrocnemius) during whole head-and-body tilts, while the opposite pattern was found during tilt with dorsiflexion. CONCLUSIONS: Our results indicate that the occurrence of tilt-evoked responses increases with an increase in the amplitude of tilting acceleration. This suggests that tilt-evoked responses are dependent, at least in part, on vestibular stimulation. In addition, the spatio-temporal pattern of biceps femoris and medial gastrocnemius muscle activation was opposite during whole head-and-body tilts and tilts with dorsiflexion. This finding suggests that foot/ankle somatosensory inputs can modify tilt-evoked responses.     

经皮神经电刺激对弛缓型脑性瘫痪患儿的效果

目的探讨经皮神经电刺激对弛缓型脑瘫患儿的临床疗效及表面肌电变化。方法40 例弛缓型脑瘫患儿分为治疗组(n=20)和对照组(n=20),两组均接受30 d 的常规康复训练,治疗组另外对股四头肌进行经皮神经电刺激治疗,每周5 次,治疗30d。治疗前后按改良Lovett 肌力测定法进行股四头肌肌力测定(Lovett 分级),粗大运动功能测试量表(GMFM)评定患儿粗大运动发育情况,同时运用表面肌电仪测定股四头肌自主收缩位表面肌电积分值(iEMG)和表面肌电信号均方根值(RMS)的变化。结果治疗后两组脑瘫患儿的Lovett 分级、GMFM评分、iEMG和RMS均较治疗前改善(P<0.05),且治疗组优于对照组(P<0.05)。结论经皮神经电刺激有利于提高弛缓型脑瘫患儿股四头肌肌张力,增强肌力,改善运动功能。     

Is neuromuscular inhibition detectable in elite footballers during the Nordic hamstring exercise?

BackgroundThe presence of neuromuscular inhibition following injury may explain the high incidence of biceps femoris injury recurrence in elite (soccer) footballers. This phenomenon may be detectable in elite players during the Nordic hamstring exercise. Thus, the first purpose of this study was to assess biceps femoris muscle activation during this exercise in players with hamstring injury history. Additionally, following injury, observed increases in synergistic muscle activation may represent a protective mechanism to the presence of neuromuscular inhibition. Thus, the second purpose was to identify if the relative contributions of biceps femoris, and its synergists reflected a post-injury pattern of activation suggestive of these potentially compensatory neural mechanisms.MethodsTen elite players with a history of hamstring injury and ten elite players without a history of hamstring injury, completed six repetitions of the Nordic hamstring exercise. During each trial, biceps femoris, semitendinosus and gluteus maximus muscle activations were collected at 90–30° and 30–0° of knee flexion.FindingsBiceps femoris activation was significantly higher at 90–30° of knee flexion compared to 30–0° (P < 0.001) but did not differ between the groups. In players with a history of injury, muscle activation ratios for the biceps femoris/semitendinosus (P = 0.001) and biceps femoris/gluteus maximus (P = 0.023) were significantly greater at 30–0° of knee flexion than in the control group.InterpretationNeuromuscular inhibition of the biceps femoris was not detected during the exercise within elite footballers, yet the relative contributions of biceps femoris and its synergists appear to change following injury.     

Effects of combined application of progressive resistance training and Russian electrical stimulation on quadriceps femoris muscle strength in elderly women with knee osteoarthritis

[Purpose] The aim of this study was to investigate the effects of combined application of progressive resistance training and Russian electrical stimulation on quadriceps femoris muscle strength in elderly women with osteoarthritis of the knee. [Subjects] Thirty women over 65 years of age diagnosed with knee osteoarthritis participated in the present study. The subjects were randomly assigned to a control group (n=10), a progressive resistance training group (n=10), or a Russian electrical stimulation group (n=10). [Methods] Each group was treated 3 times weekly for 8 weeks, and each session lasted 45 minutes. Muscle strength was assessed by measuring the peak torque of the quadriceps femoris muscle. Outcome measurements were performed at baseline and at the fourth and eighth weeks of the treatment period. [Results] All groups showed significant intragroup differences in the quadriceps femoris muscle peak torque after the treatment intervention. There were significant intergroup differences between the Russian electrical stimulation group and the other groups. [Conclusion] The results of this study suggest that combined application of progressive resistance training and Russian electrical stimulation can be effective in strengthening the quadriceps femoris muscle in elderly women with knee osteoarthritis.Key words: Knee osteoarthritis, Progressive resistance training, Russian electrical stimulation     

Altered hamstring-quadriceps muscle balance in patients with knee osteoarthritis

BACKGROUND: To compare hamstring to quadriceps muscle coactivity during level walking, stair ascent, and stair decent between individuals with and without knee osteoarthritis. METHODS: In a cross-sectional study, subjects with grade II knee osteoarthritis (n = 26), healthy age- and gender-matched (n = 20) and healthy, young adults (n = 20) performed three activities of daily living. During the stance phase of these activities surface electromyography was measured. Two coactivity ratios were computed, the biceps femoris to vastus lateralis ratio and the ratio of the biceps femoris EMG activity relative to the EMG activity measured during contraction- and velocity-specific maximal voluntary biceps femoris contraction, i.e., biceps femoris to maximal biceps femoris activity. FINDINGS: Subjects with knee osteoarthritis had significantly higher coactivity than age-matched healthy adults and young adults and healthy adults had more coactivity than young adults regardless the type of coactivity ratio. The biceps femoris to vastus lateralis ratio yielded 25% higher coactivity value than the biceps femoris to maximal biceps femoris ratio (P < 0.0001). The EMG activity of the vastus lateralis relative to maximal vastus lateralis EMG activity was 92% in subjects with knee osteoarthritis, 57% in age-matched controls, and 47% in young adults (P < 0.0001). INTERPRETATION: Patients with knee osteoarthritis revealed increased hamstring muscle activation while executing activities of daily living. Altered muscle activation at the knee may interfere with normal load distribution in the knee and facilitate disease progression. Therapeutic interventions should focus not only on quadriceps strengthening but also on improving muscle balance at the knee.     

腘绳肌转移矫治青少年股四头肌麻痹

目的探讨绳肌髌韧带转移矫治青少年儿麻后遗症 (股四头肌麻痹 )的疗效与优越性。方法治疗组 5 6例用绳肌髌韧带转移术重建股四头肌功能 ,对照组 43例用绳肌髌骨转移代股四头肌术。结果 2组均随访 1- 4年 ,治疗组手术优良率 87.5 % ,对照组 6 9.8% ,2组比较差异有显著性 (P<0 .0 5 )。结论绳肌髌韧带转移矫治青少年股四头肌麻痹疗效好 ,并发症少 ,操作简便 ,手术时间短 ,失血少 ,成功率高 ,但要掌握手术适应症、手术年龄与手术时机     

Effects of fast and slow squat exercises on the muscle activity of the paretic lower extremity in patients with chronic stroke

[Purpose] The purpose of this study was to investigate the effects of the speed of squat exercises on paretic lower extremity muscle activity in patients with hemiplegia following a stroke. [Subjects and Methods] Ten stroke patients performed fast and slow squat exercises for 2 seconds and 8 seconds, respectively. The muscle activities of the paretic and non-paretic sides of the rectus femoris muscle, the biceps femoris muscle, and the tibialis anterior muscle were assessed and compared using surface electromyography. [Results] The paretic side of the rectus femoris muscle showed statistically significant differences in the fast squat exercise group, which demonstrated the highest muscle activity during the rapid return to the upright position. [Conclusion] The rectus femoris muscle showed the highest muscle activity during the return to the upright position during the fast squat exercise, which indicates that the rectus femoris muscle is highly active during the fast squat exercise.Key words: Fast and slow squat exercise, Muscle activity, Chronic strokes     

Quantitative muscle ultrasonography in amyotrophic lateral sclerosis

In this study, we examined whether quantitative muscle ultrasonography can detect structural muscle changes in early-stage amyotrophic lateral sclerosis (ALS). Bilateral transverse scans were made of five muscles or muscle groups (sternocleidomastoid, biceps brachii/brachialis, forearm flexor group, quadriceps femoris and anterior tibialis muscles) in 48 patients with ALS. Twenty-five patients were also screened for fasciculations. Quantitative analysis revealed a significant increase in echo intensity in all muscles and a decrease in muscle thickness of the biceps brachii, forearm flexors and quadriceps femoris on both sides. Fasciculations were easy to detect in multiple muscles of all screened patients except one. We conclude that quantitative ultrasonography can be used to detect muscle changes caused by ALS in an early phase of the disease. (E-mail: m.zwarts@neuro.umcn.nl).     

Motor branch block of the rectus femoris: its effectiveness in stiff-legged gait in spastic paresis

OBJECTIVE: To verify the efficacy of motor branch block of the rectus femoris for stiff-legged gait in spastic patients. DESIGN: Before-after treatment trial. SETTING: University hospital physical medicine and rehabilitation department outpatient clinic. PATIENTS: Thirty-one adult spastic patients with stiff-legged gait. INTERVENTION: Motor branch block of the rectus femoris with 2% lidocaine and 5% phenol. OUTCOME MEASURES: Subjective assessment of gait performance by patients themselves and objective assessment of gait speed and sagittal knee kinematics. RESULTS: Seventy-four percent (23/31) of patients felt an improvement (improved knee bending, disappeared toe dragging) after nerve block with lidocaine. Sixteen of 17 patients with an abnormal swing phase activity of the rectus femoris without that of the vastus medialis or lateralis and 20 of 23 patients with a sufficient hip flexor strength expressed an improvement subjectively. Gait analysis showed increased maximal knee flexion at swing phase and increased slope of knee flexion curve at toe off (p < .05). Phenol block was performed in 19 of 23 patients who had had a subjective improvement in their gait performance after nerve block with lidocaine. Gait speed, maximal knee flexion angle at swing phase, and slope of knee flexion curve at toe off increased significantly after phenol block (p < .05). CONCLUSION: Motor branch block of the rectus femoris can be an effective treatment in stiff-legged gait. Its effect is varied with hip flexor strength and dynamic electromyographic findings of quadriceps.